Basic Information
| Provider Information | |||||||||
| NPI: | 1346679974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOWAN | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | COTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7618 BERKELEY PL NE | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983114018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189735872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2701 CLARE AVE | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603773951 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OC60262132 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.